A rectovaginal fistula is an abnormal connection between the rectum and the vagina. In this case, gas or stool may leak from the intestine into the vagina. It can be caused by physical trauma or a medical condition. You can find more information below.
What is a rectovaginal fistula?
A rectovaginal fistula is an abnormal connection between the vagina and rectum. A fistula is defined as an opening that should not exist between a hollow organ (such as the vagina) and another hollow organ (such as the anus). The term rectovaginal describes two organs where the opening is located between the rectum and the vagina. This gas can cause mucus and stool to leak into the vagina, unpleasant odors, infection, and other problems.
Rectovaginal fistula is a type of obstetric fistula or urogenital fistula . These are terms that describe all openings between the genitals and the urinary and intestinal tract. Another obstetric fistula type is vesicovaginal fistula . This is an opening between the vagina and the bladder, which can cause urine to leak into the vagina without trying to urinate.
For some women, a rectovaginal fistula can be emotionally devastating. Women with a rectovaginal fistula often report difficulties with self-esteem and close relationships. Fortunately, this condition is relatively rare and rectovaginal fistulas can often be treated. In addition, the risk of rectovaginal fistula is particularly low in countries with well-trained childbirth support.
What causes a rectovaginal fistula?
The most common causes of rectovaginal fistula are:
- Complications during childbirth: During a long or difficult delivery, the perineum may tear, or your doctor may make an incision ( episiotomy ) in the perineum (between the anus and the vagina) to retrieve the baby.
- Inflammatory bowel disease: The inflammatory bowel diseases Crohn’s disease and ulcerative colitis cause inflammation in the digestive tract. In rare cases, these conditions can increase your risk of developing fistulas.
- Cancer or radiation in the pelvis (pelvis): Cancer in your vagina, cervix, rectum, uterus, or anus can cause a rectovaginal fistula. Radiation to treat these cancers can also create a fistula.
- Surgery: Having surgery on your vagina, rectum, perineum, or anus can result in injury or infection that leads to an abnormal opening.
Other possible causes are:
- an infection in your anus or rectum
- Infected bags in your intestines ( diverticulitis )
- Compression of stool in the rectum
- HIV -related infections
- sexual assault
Who is at risk?
You are more likely to have a rectovaginal fistula if:
- work in a difficult job
- Tearing or incision of the perineum or vagina during childbirth ( episiotomy )
- have Crohn’s disease or ulcerative colitis
- you have an infection such as an abscess or diverticulitis
- Receiving radiation therapy to treat certain types of cancer, such as cancer of the vagina, cervix, rectum, uterus, or anus
- Performing hysterectomy or other surgical procedures in the pelvic area
What are the symptoms of rectovaginal fistula?
Rectovaginal fistulas can cause a variety of symptoms, some of which are:
- Stool or gas coming from your vagina
- Trouble controlling bowel movements (stooling)
- A smelly discharge from your vagina
- Repeated vaginal infections
- Pain in the vagina or the area between the vagina and anus (perineum)
- pain during sexual intercourse
If you have any of these symptoms, you should consult your doctor.
Which doctor should I go to for rectovaginal?
The doctor you should go to for the treatment of rectovaginal fistula or this problem should be a doctor who specializes in obstetrics and gynecology.
How is a rectovaginal fistula diagnosed?
Talking about a rectovaginal fistula can be difficult. Still, it’s important to tell your doctor about your symptoms so you can be treated.
Your doctor will first ask about your symptoms and perform a physical exam. With a gloved hand, he will check the vagina, anus and between. A device called a speculum may be inserted into the vagina so your doctor can see the area more clearly. A proctoscope can help your doctor see your anus and rectum.
Tests your doctor may use to diagnose a rectovaginal fistula include:
- Anorectal or transvaginal ultrasound: During this test, a wand-like instrument is inserted into your rectum or vagina. Ultrasound uses sound waves to create a picture from inside your pelvis.
- Methylene enema: A tampon is inserted into the vagina. A blue dye is then injected into your rectum. If the tampon turns blue after 15 to 20 minutes, you have a fistula.
- Barium enema: You get a contrast dye that helps your doctor see the fistula on an X- ray .
- Computed tomography scan: Also known as a CT scan , it uses powerful X-rays to make detailed pictures of your pelvis.
- Magnetic resonance imaging: Magnetic resonance imaging uses powerful magnets and radio waves to make pictures from inside your pelvis. It can also indicate other problems, such as a fistula or a tumor in your organs.
How is a rectovaginal fistula treated?
The main treatment for a fistula is surgery to close the abnormal opening. However, you cannot have surgery if you have an infection or inflammation. First, the tissues around the fistula need to heal.
Your doctor may suggest waiting three to six months for an infection to heal and to see if the fistula closes on its own. If you have Crohn’s disease, you may take antibiotics to reduce inflammation and treat the infection.
Rectovaginal fistula surgery can be done through the abdomen, vagina or perineum. During surgery, your doctor will take a piece of tissue from another part of your body and make a flap or plug to close the opening. The surgeon also straightens the anal sphincter muscles if they are damaged.
Some women need a colostomy . This surgery creates an opening in your belly wall called a stoma . The end of your large intestine is passed through the opening. A bag collects the waste until the fistula heals.
You can go home the same day as your surgery. For some types of surgery, you need to stay in the hospital overnight.
Possible risks from surgery include:
- Damage to the bladder, ureters, or bowel
- blood clot in the legs or lungs
- Obstruction in the bowel
How is a rectovaginal fistula managed?
To help you feel better while waiting for surgery, you can try the following:
- Take any antibiotics or other medications your doctor has prescribed.
- Keep the area clean. If you have stool or a foul-smelling discharge, gently wash your vagina with warm water. Use only mild, unscented soap and then dry the area.
- When using the toilet, use unscented tissue instead of toilet paper.
- Apply powder or cream to your vagina and rectum to prevent irritation.
- Wear loose, breathable underwear made from cotton or other natural fabrics.
- If you are leaking stool, use disposable underwear or adult diapers to keep the stool away from your skin.
Sometimes the rectovaginal fistula closes on its own, but most of the time, surgery is required to correct the problem.
The success of the surgery depends on many things. Abdominal surgery has the highest success rate of 95%. The success of surgery performed through the vagina or rectum is approximately 55%. If the first surgery doesn’t work, you will need another procedure.
Rectovaginal fistula can affect your sex life. Other complications include:
- Trouble controlling the passage of stool (fecal incontinence)
- Recurrent urinary tract or vaginal infections
- Inflammation of the vagina or perineum
- abscess in fistula
- Formation of another fistula after the first one has been treated